Schizophrenia

Spectrum and
Other Psychotic
Disorders
Schizophrenia spectrum and other psychotic disorders
include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined
by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized
thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative
symptoms.
🞆 SCHIZOPHRENIA
DEFINITION: A devastating psychotic disorder that may involve characteristic disturbances in
thinking (delusions), perception (hallucinations), speech, emotions, and behavior.
CHARACTERISTIC: The appearance of a patient with schizophrenia can range from that of a
completely disheveled, screaming, agitated person to an obsessively groomed, completely silent
and immobile person. Between these two poles, patients may be talkative and may exhibit bizarre
postures.
Patients with schizophrenia may be agitated and have little impulses control when ill. They may
also have decreased social sensitivity and appear to be impulsive.
CLINICAL SIGNS AND SYMPTOMS
▪ POSITIVE SYMPTOPMS
DELUSIONS: A psychotic symptom involving disorder of thought content and presence
of strong beliefs that are misrepresentations of reality.
HALLUCINATIONS: A psychotic symptom of perceptual disturbance in which
something is seen, heard, or otherwise sensed although it is not actually present.
▪ NEGATIVE SYMPTOMS
AVOLITION is the inability to initiate and persist in activities. People with this
symptom (also referred to as apathy) show little interest in performing even the most
basic day-to-day functions, including those associated with personal hygiene.
ALOGIA refers to the relative absence of speech. A person with alogia may respond to
questions with brief replies that have little content and may appear uninterested in the
conversation.
ANHEDONIA the presumed lack of pleasure experienced by some people with a
psychological disorder.
AFFECTIVE FLATTENING They are similar to people wearing masks because they
do not show emotions when you would normally expect them to. They may stare at you
vacantly, speak in a flat and toneless manner, and seem unaffected by things going on
around them. However, although they do not react openly to emotional situations, they
may be responding on the inside.
▪ DISOGANIZED SYMPTOMS
DISORGANIZED SPEECH A style of talking often seen in people with schizophrenia,
involving incoherence and a lack of typical logic patterns.
 INAPPROPRIATE AFFECT An emotional display that is improper for the situation.
TYPES
a) PARANOID TYPE
The paranoid type of schizophrenia is characterized by preoccupation with one or more delusions or
frequent auditory hallucinations. Classically, the paranoid type of schizophrenia is
characterized mainly by the presence of delusions of persecution or grandeur.
Patients with paranoid schizophrenia are typically tense, suspicious, guarded, reserved, and
sometimes hostile or aggressive, but they can occasionally conduct themselves adequately in
social situations. Their intelligence in areas not invaded by their psychosis tends to remain
intact.
b) DISORGANIZED TYPE
The disorganized type of schizophrenia is characterized by a marked regression to primitive,
disinhibited, and unorganized behavior and by the absence of symptoms that meet the criteria
for the catatonic type.
Disorganized patients are usually active but in an aimless, nonconstructive manner. Their thought
disorder is pronounced, and their contact with reality is poor. Their personal appearance is
disheveled, and their social behavior and their emotional responses are inappropriate. They
often burst into laughter without any apparent reason. Incongruous grinning and grimacing
are common in these patients, whose behavior is best described as silly or fatuous.
c) CATATONIC TYPE
The classic feature of the catatonic type is a marked disturbance in motor function; this disturbance
may involve stupor, negativism, rigidity, excitement, or posturing. Sometimes the patient
shows a rapid alteration between extremes of excitement and stupor. Associated features
include stereotypies, mannerisms, and waxy flexibility. Mutism is particularly common.
During catatonic excitement, patients need careful supervision to prevent them from hurting
themselves or others. Medical care may be needed because of malnutrition, exhaustion,
hyperpyrexia, or self-inflicted injury.
d) UNDIFFERENTIATED TYPE
Frequently, patients who clearly have schizophrenia cannot be easily fit into one type or another.
These patients are classified as having schizophrenia of the undifferentiated type.
e) RESIDUAL TYPE
The residual type of schizophrenia is characterized by continuing evidence of the schizophrenic
disturbance in the absence of a complete set of active symptoms or of sufficient symptoms to
meet the diagnosis of another type of schizophrenia. Emotional blunting, social withdrawal,
eccentric behavior, illogical thinking, and mild loosening of associations commonly appear in
the residual type. When delusions or hallucinations occur, they are neither prominent nor
accompanied by strong affect.

DIAGNOSTIC CRITERIA
A. Two (or more) of the following, each present for a significant portion of time during a 1-month
period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
 5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one
or more major areas, such as work, interpersonal relations, or self-care, is markedly below the
level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure
to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must
include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e.,
active-phase symptoms) and may include periods of prodromal or residual symptoms. During
these prodromal or residual periods, the signs of the disturbance may be manifested by only
negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated
form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been
ruled out because either 1) no major depressive or manic episodes have occurred concurrently
with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase
symptoms, they have been present for a minority of the total duration of the active and residual
periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset,
the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in
addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or
less if successfully treated).
Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they
are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting the
defining diagnostic symptom and time criteria. An acute episode is a time period in which the
symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a period of time during which
an improvement after a previous episode is maintained and in which the defining criteria of the
disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a previous
episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined after a
minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining
for the majority of the illness course, with subthreshold symptom periods being very brief relative
to the overall course.
Unspecified
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp.
119–120, for definition).
 Coding note: Use additional code 293.89 (F06.1) catatonia associated with schizophrenia
to indicate the presence of the comorbid catatonia.

Specify current severity:

Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-
Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of schizophrenia can be made without using this severity specifier.

🞆 SCHIZOAFFECTIVE DISORDER
DEFINITION: A psychotic disorder featuring symptoms of both schizophrenia and major mood
disorder.
CHARACTERISTICS: The diagnosis of schizoaffective disorder is based on the assessment of
an uninterrupted period of illness during which the individual continues to display active or
residual symptoms of psychotic illness. The diagnosis is usually, but not necessarily, made during
the period of psychotic illness.
CLINICAL SIGNS AND SYMPTOMS
▪ Major mood episode (major depressive or manic)
Criterion A from Schizophrenia:
▪ Delusions
▪ Hallucinations
▪ Disorganized Thinking (Speech)
▪ Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
▪ Negative Symptoms
TYPES
a) BIPOLAR TYPE, which includes episodes of mania and sometimes major depression
b) DEPRESSIVE TYPE, which includes only major depressive episodes

DIAGNOSIS CRITERIA
A. An uninterrupted period of illness during which there is a major mood episode (major depressive
or manic) concurrent with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1: Depressed mood.
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode
(depressive or manic) during the lifetime duration of the illness.
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total
duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a
medication) or another medical condition
Specify whether:
295.70 (F25.0) Bipolar type: This subtype applies if a manic episode is part of the presentation.
Major depressive episodes may also occur.
295.70 (F25.1) Depressive type: This subtype applies if only major depressive episodes are part
of the presentation.
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp.
119–120, for definition).
Coding note: Use additional code 293.89 (F06.1) catatonia associated with
schizoaffective disorder to indicate the presence of the comorbid catatonia.
Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they
are not in contradiction to the diagnostic course criteria.
First episode, currently in acute episode: First manifestation of the disorder meeting the
defining diagnostic symptom and time criteria. An acute episode is a time period in which the
symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a time period during which an
improvement after a previous episode is maintained and in which the defining criteria of the
disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a previous
episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined after a
minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining
for the majority of the illness course, with subthreshold symptom periods being very brief relative
to the overall course.
Unspecified
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-
Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of schizoaffective disorder can be made without using this severity specifier.
 Note: For additional information on Development and Course (age-related factors), Risk and
Prognostic Factors (environmental risk factors), Culture-Related Diagnostic Issues, and Gender-
Related Diagnostic Issues, see the corresponding sections in schizophrenia, bipolar I and II disorders,
and major depressive disorder in their respective chapters.

🞆 SCHIZOPHRENIFORM DISORDER
DEFINITION: Schizophreniform disorder is characterized by comparatively stable psychotic
symptoms that fulfil the diagnostic criteria for schizophrenia and last for more than one month but
for less than six months. Mood disorders, organic disorders, and substance misuse should be
excluded. Onset is brief and symptoms are present at least most of the time.
CHARATERISTIC: the symptoms last for at least 1 month but less than 6 months. In contrast,
for a patient to meet the diagnostic criteria for schizophrenia, the symptoms must have been
present for at least 6 months. Patients with schizophreniform disorder return to their baseline
level of functioning after the disorder has resolved.
CLINICAL SIGNS AND SYMPTOMS:
▪ Delusions
▪ Hallucinations
▪ Disorganized speech (e.g., frequent derailment or incoherence)
▪ Grossly disorganized or catatonic behavior.
▪ Negative symptoms (i.e., diminished emotional expression or avolition).
DIAGNOSTIC CRITERIA
A. Two (or more) of the following, each present for a significant portion of time during a 1-month
period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must
be made without waiting for recovery, it should be qualified as “provisional.”
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been
ruled out because either 1) no major depressive or manic episodes have occurred concurrently
with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase
symptoms, they have been present for a minority of the total duration of the active and residual
periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.
Specify if:
 With good prognostic features: This specifier requires the presence of at least two of the following
features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in
usual behavior or functioning; confusion or perplexity; good premorbid social and occupational
functioning; and absence of blunted or flat affect. Without good prognostic features: This specifier is
applied if two or more of the above features have not been present.
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp.
119–120, for definition).
Coding note: Use additional code 293.89 (F06.1) catatonia associated with
schizophreniform disorder to indicate the presence of the comorbid catatonia.
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-
Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”) Note:
Diagnosis of schizophreniform disorder can be made without using this severity specifier.
Note: For additional information on Associated Features Supporting Diagnosis, Development and
Course (age-related factors), Culture-Related Diagnostic Issues, Gender-Related Diagnostic
Issues, Differential Diagnosis, and Comorbidity, see the corresponding sections in schizophrenia.

🞆 DELUSIONAL DISORDER
DEFINITION: A psychotic disorder featuring a persistent belief contrary to reality (delusion)
but no other symptoms of schizophrenia.
CHARACTERISTICS: The major feature of delusional disorder is a persistent belief that is
contrary to reality in the absence of other characteristics of schizophrenia. This disorder is
characterized by a persistent delusion that is not the result of an organic factor such as brain
seizures or of any severe psychosis
CLINICAL SIGNS AND SYMPTOMS
Individuals with delusional disorder tend not to have flat affect, anhedonia, or other negative
symptoms of schizophrenia; it is important to note; however, they may become socially isolated
because they are suspicious of others. The delusions are often long-standing, sometimes
persisting over several years.
TYPES
a) Erotomanic type: This subtype applies when the central theme of the delusion is that
another person is in love with the individual.
b) Grandiose type: This subtype applies when the central theme of the delusion is the
conviction of having some great (but unrecognized) talent or insight or having made
some important discovery.
 c) Jealous type: This subtype applies when the central theme of the individual’s delusion is
that his or her spouse or lover is unfaithful.
d) Persecutory type: This subtype applies when the central theme of the delusion involves
the individual’s belief that he or she is being conspired against, cheated, spied on,
followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the
pursuit of long-term goals.
e) Somatic type: This subtype applies when the central theme of the delusion involves
bodily functions or sensations.
f) Mixed type: This subtype applies when no one delusional theme predominates.
g) Unspecified type: This subtype applies when the dominant delusional belief cannot be
clearly determined or is not described in the specific types (e.g., referential delusions
without a prominent persecutory or grandiose component).
DIAGNOSTIC CRITERIA
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not
prominent and are related to the delusional theme (e.g., the sensation of being infested with
insects associated with delusions of infestation).
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly
impaired, and behavior is not obviously bizarre or odd.
D. If manic or major depressive episodes have occurred, these have been brief relative to the
duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical
condition and is not better explained by another mental disorder, such as body dysmorphic
disorder or obsessive-compulsive disorder.
Specify whether:
Erotomanic type: This subtype applies when the central theme of the delusion is that another
person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the delusion is the conviction of
having some great (but unrecognized) talent or insight or having made some important discovery.
Jealous type: This subtype applies when the central theme of the individual’s delusion is that his
or her spouse or lover is unfaithful.
Persecutory type: This subtype applies when the central theme of the delusion involves the
individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned
or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.
Somatic type: This subtype applies when the central theme of the delusion involves bodily
functions or sensations.
Mixed type: This subtype applies when no one delusional theme predominates.
Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly
determined or is not described in the specific types (e.g., referential delusions without a
prominent persecutory or grandiose component).
Specify if:
With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not
understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a
 stranger has removed his or her internal organs and replaced them with someone else’s organs
without leaving any wounds or scars).
Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder:
First episode, currently in acute episode: First manifestation of the disorder meeting the defining
diagnostic symptom and time criteria. An acute episode is a time period in which the symptom
criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a time period during which an
improvement after a previous episode is maintained and in which the defining criteria of the disorder
are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a previous episode
during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for
the majority of the illness course, with subthreshold symptom periods being very brief relative to the
overall course.
Unspecified
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated
Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of delusional disorder can be made without using this severity specifier.

🞆 BRIEF PSYCHOTIC DISORDER

DEFINTION: A psychotic disturbance involving delusions, hallucinations, or disorganized
speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor.
CHARACTERISTIC: Brief psychotic disorder resembles an acute episode of schizophrenia and
is characterized by prominent positive symptoms such as delusions and hallucinations, a rapid
onset, a short course of less than one month (by definition), and a complete recovery.
CLINICAL SYMPTOMS
▪ Delusions.
▪ Hallucinations.
▪ Disorganized speech (e.g., frequent derailment or incoherence).
▪ Grossly disorganized or catatonic behavior.
DIAGNOSTIC CRITERIA
 A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or
(3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual
full return to premorbid level of functioning.
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic
features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to
the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical
condition.
Specify if:
With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events
that, singly or together, would be markedly stressful to almost anyone in similar circumstances in
the individual’s culture.
Without marked stressor(s): If symptoms do not occur in response to events that, singly or
together, would be markedly stressful to almost anyone in similar circumstances in the
individual’s culture.
With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum.
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp.
119–120, for definition)
Coding note: Use additional code 293.89 (F06.1) catatonia associated with brief
psychotic disorder to indicate the presence of the comorbid catatonia.
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative
symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7
days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-
Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of brief psychotic disorder can be made without using this severity specifier.

PSYCHOTIC DISORDER DUE TO A GENERAL MEDICAL CONDITION. The diagnosis of

psychotic disorder due to a general medical condition is defined by specifying the predominant
symptoms. When the diagnosis is used, the medical condition, along with the predominant symptoms
pattern, should be included in the diagnosis (e.g., psychotic disorder due to a brain tumor, with delusions).
The disorder does not occur exclusively while a patient is delirious or demented, and the symptoms are
not better accounted for by another mental disorder.
DIAGNOSTIC CRITERIA
A. Prominent hallucinations or delusions.
B. There is evidence from the history, physical examination, or laboratory findings that the
disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
Specify whether:
Code based on predominant symptom:
293.81 (F06.2) With delusions: If delusions are the predominant symptom.
293.82 (F06.0) With hallucinations: If hallucinations are the predominant symptom.
Coding note: Include the name of the other medical condition in the name of the mental disorder
(e.g., 293.81 [F06.2] psychotic disorder due to malignant lung neoplasm, with delusions). The other
medical condition should be coded and listed separately immediately before the psychotic disorder
due to the medical condition (e.g., 162.9 [C34.90] malignant lung neoplasm; 293.81 [F06.2]
psychotic disorder due to malignant lung neoplasm, with delusions).
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including
delusions, hallucinations, abnormal psychomotor behavior, and negative symptoms. Each of these
symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale
ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of
Psychosis Symptom Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of psychotic disorder due to another medical condition can be made without
using this severity specifier.
SUBSTANCE- OR MEDICATION-INDUCED PSYCHOTIC DISORDER. The diagnostic category
of substance-induced psychotic disorder is reserved for those with psychotic symptoms and impaired
reality testing caused by substances or medications. People with substance-induced psychotic symptoms
(e.g., hallucinations) but with intact reality testing should be classified as having a substance-related
disorder (e.g., PCP intoxication with perceptual disturbances). The full diagnosis of substance-induced
psychotic disorder should include the type of substance or medication involved, the stage of substance use
when the disorder began (e.g., during intoxication or withdrawal), and the clinical phenomena (e.g.,
hallucinations or delusions).
DIAGNOSTIC CRITERIA
A. Presence of one or both of the following symptoms:
1. Delusions.
2. Hallucinations.
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and
(2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.
 C. The disturbance is not better explained by a psychotic disorder that is not substance/ medication-
induced. Such evidence of an independent psychotic disorder could include the following:
D. The symptoms preceded the onset of the substance/medication use; the symptoms persist for a
substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe
intoxication; or there is other evidence of an independent non-substance/medication-induced
psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).
E. The disturbance does not occur exclusively during the course of a delirium. E. The disturbance
causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
Note: This diagnosis should be made instead of a diagnosis of substance intoxication or substance
withdrawal only when the symptoms in Criterion A predominate in the clinical picture and when they are
sufficiently severe to warrant clinical attention.